On July 20, 2011, CMS published a proposed rule to implement the Consumer Operated and Oriented Plan (CO–OP) program, which was mandated by the Affordable Care Act (ACA) to provide loans to encourage the creation of consumer-governed, private, nonprofit health insurance issuers. CO-Ops will offer qualified health plans to individuals and small businesses through new Affordable Insurance Exchanges (Exchanges), and may offer coverage to small businesses through state ”Small Business Health Option Programs.” The ACA provides $3.8 billion for the CO-OP program, with the goal of having at least one CO-OP in each state. The proposed rule would: (1) establish eligibility standards for the CO–OP program; (2) establish certain loan terms; and (3) provide basic standards that organizations must meet to become a CO-OP and participate in this program. CMS will accept comments on the proposed rule until September 16, 2011.